The last thing the world needs is another global health crisis. The Ebola outbreak has been and still continues to be one of the wildest and most violent epidemics we have yet to encounter. The job done by many health organisations to quarantine infected patients has been remarkable, and has prevented thousands more lives from being lost. But there still remain some infections that have done more damage this year, and cannot be quarantined or eradicated. General bacterial infections seem so mundane they barely get notice, thanks to the abundance of antibiotics and a host of preventive measures. The problem now however, is that a lot of the bacteria are becoming increasingly antibiotic resistant. And so just like Ebola, these things have no cure but unfortunately unlike Ebola, there can be no vaccine.
Bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) also known as the ‘Super Bug’ and multi-drug-resistant Mycobacterium tuberculosis (MDR-TB) have become more problematic over the years. In the US alone, antibiotic resistant bacteria affect 2 million people per year, leading to 23,000 deaths, and an extra $20 billion in medical costs. In Europe these bacteria lead to the death of over 25,000 annually, with medical costs close to that of the US. In areas with poorer medical records than the US and Europe, this figure is significantly higher. MRSA alone is responsible for more deaths in the US than HIV/AIDS, homicides and Parkinsons put together, according to the Infectious Disease Society of America.
The gravity of the threat is undeniable, a point which is constantly being stressed by every medical organisation in the world, including the World Health Organisation (WHO). The greater concern isn’t how bad the resistant bacteria are, but how little is being done to stop them. The need for new antibiotics is evident, but pharmaceutical companies have been slow to take up the challenge, as antibiotics are not very profitable. On average it takes 10 years to release a new drug at the cost of US$1 billion. Antibiotics are only used for a few days at a time, unlike medication for chronic illnesses, which are used daily for extended periods of time. These drugs generate enough revenue for the trouble it takes to create them. The moral argument may not be able to sway pharmaceuticals, as the costs involved could bankrupt most of them, especially if the drug doesn’t end up getting state approval. The other problem with antibiotics is that most of them begin to lose efficacy after a few years. Bacteria develop antibiotic resistance when the drug is overused. So after a few years, they would become resistant to the very same antibiotics created to destroy them. That is a lot of money spent on a drug that will only last a couple of years. Pharmaceuticals would rather invest in drugs that have the same impact no matter how often they are used like anti-inflammatory drugs and antidepressants.
The cooperation needs to be spurred somehow, and the American government seems to have found the way. Right now only five of the major pharmaceutical companies are engaging in research on new antibiotics, but none of their drugs have novel ideas, meaning even these new products will need to be changed soon after. They haven’t yet discovered new ways of fighting bacteria, but it still is a work in progress. 45 new antibiotics are being developed, 80 percent of which are being done by small companies. With the new legislation passed in the US, more companies will be encouraged to carry out antibiotic research. Antibiotic makers can now gain more rewards for their labour as the Generating Antibiotic Incentives Now (GAIN) Act has lengthened the period of exclusive rights for antibiotics, meaning companies can hold their patents for an additional five years. This could be the difference between loss and substantial profit, and this is exactly the kind of news small pharmaceuticals companies have been waiting for. 17 of these drugs under development have qualified for benefits under the GAIN Act.
One of the companies benefitting from the new legislation is Cubist Pharmaceuticals. Their antibiotic Sivextro, was given approval in June to treat skin infections by the U.S. Food and Drug Administration (FDA). This is at the back of their successful drug Cubicin, which is one of the few antibiotics used to treat MRSA. GlaxoSmithKline is another company taking advantage of the new development. They are one of many companies investing in Spero Therapeutics, a company researching solutions to gram-negative bacteria. Gram-negative bacteria are particularly resistant to antibiotics and multiple drugs, causing many pharmaceuticals to shy away from what might seem like a dead-end. Cubist is also looking into antibiotics for gram-negative bacteria. Companies like Roche and AstraZeneca are partnering up with small biotech companies to do research on antibiotics. These specialist companies will carry out the initial phases of research into new ways of fighting the bacteria, and will receive increased financial investment as their drugs yield dividends. This keeps large firms from spreading their resources too thin, and it allows antimicrobial companies to continue specialising.
The question is: will it be enough or is it already too late? Pharmaceutical companies began to shy away from Antibiotics in the 90s, which has led to the problems we are facing now. Governmental agencies are trying to rectify this by diversifying their attention away from companies. They are funding university programs such as Harvard’s Program on Antibiotic Resistance. These research institutions are not trying to come up with new drugs, but they are looking for the most viable options, which will then be pursued by companies with the funding and experience to produce them. This significantly reduces the pressure on pharmaceutical companies as they won’t be working alone, and the information they’ll be receiving won’t cost them anything. Despite these solutions however, it could all be a little late.
The United Nations World Health Organisation has warned that all we hold dear in modern medicine could collapse if new antibiotics are not discovered soon. As bacteria tend to infect wounds and cuts – whether accidental or surgical, it could be too risky to perform any kind of operation. The patient could be infected by something worse than the initial diagnosis and succumb to the super bugs. Hospitals are already not the safest place to be as these bacteria reside there, but without the presence of antibiotics that work, nowhere would be safe. Not unless something can be done about it now. The Infectious Disease Agency of America is trying to push for at least 10 new antibiotics to hit the market by 2020. The US legislation signed in 2012 has been a big help, but whether it will help meet this requirement within this time-frame is too early to tell.
The duty of discovering new antibiotics isn’t just a job for the large companies in the US and Europe alone, but pharmaceutical companies the world over. China is trying to put in place a firm strategy to get firms to find new antibiotics as well, and has even partnered with Sweden on the project. With WHO and other leading health organisations pushing the charge, we are sure to see more countries support the cause and implement legislation like that in the US. It is clear that this push will not come from pharmaceutical companies, as the risks for them and for the other useful drugs they produce are too high. If governments do not find a way to entice antibiotic development, it will be up to citizens to fund research.
2014 has been a good year for antibiotic research and production; let us hope it keeps up.